Random inspection report
Care homes for older people
Name: Address: Daisy Bank Nursing Home c/o Jackson, Dyson & Blundell 17-19 Leek Road Cheadle Staffordshire ST10 1JE one star adequate service 22/09/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Mathias Foundling-Miah Date: 2 3 1 2 2 0 0 9 Information about the care home
Name of care home: Address: Daisy Bank Nursing Home c/o Jackson, Dyson & Blundell 17-19 Leek Road Cheadle Staffordshire ST10 1JE 01538750439 01538750439 daisybankcheadle@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Classic Care Homes Limited care home 32 Number of places (if applicable): Under 65 Over 65 4 32 6 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 32 Physical disability - over 65 years of age (PD(E)) 6 Dementia - over 65 years of age (DE(E)) 4 Date of last inspection Brief description of the care home Daisy Bank is a care home providing personal care including nursing care for up to 32 elderly people. This includes care for up to six people over the age of 65 years with
Care Homes for Older People Page 2 of 11 2 2 0 9 2 0 0 9 Brief description of the care home physical disabilities, and dementia care for up to four people over the age of 65 years. The Nursing Home is owned by Classic Care Homes Limited and is located in the market town of Cheadle, Staffordshire. Cheadle town centre is closeby. It has a wide selection of amenities such as shops, leisure facilities, public houses, banks and churches. The home stands well off the road. Accommodation is provided on two floors. There is a passenger lift to provide easy access. There is ample on site car parking and the gardens are accessible around the home to people who use the service, including wheelchair users. The accommodation provides for twenty single bedrooms, with six shared (double) bedrooms. There is ample provision of toilet and bathing facilities including a wetroom/shower, communal lounges, dining room and seating areas. Care Homes for Older People Page 3 of 11 What we found:
The reason for this inspection was to assess compliance with the following two requirements made. This included concerns evidenced during a visit by Linda Clowes (Regulation Inspector) on a key Inspection on 22nd September 2009. The pharmacist Inspection visit on 23rd December 2009 involved examination of medicines, storage facilities, medicine charts and records. We case tracked two people living in the service. Discussions took place with the proprietor, the senior nurse in charge and deputy matron on duty, during the time of the inspection. Feedback was provided and the outcome of this inspection is as follows: The service must ensure that all medication held in the care home is stored at temperatures recommended by the manufacturer. This will ensure that medication retains its properties and potency and is safe to administer to people who use the service. A policy, instructions and a notice Daily Fridge Temp Check were available informing the staff to maintain fridge temperatures and to report any variations. We observed that daily recordings of fridge temperature were made and maintained within the appropriate range. Medication requiring storage were correctly found and stored in the fridge, including unopened Insulin, antibiotic mixtures and eye drops with dates of opening except for one eye drop bottle. Daily recordings of the external room temperature were made and the room maintained below 25 Celsius. We were provided with a copy of the improvement plan completed by the home of what improvements the home has made. This tells you that the trained staff are aware of recording fridge temperatures on a daily basis and reporting any problems. This indicates that this requirement has been met. The administration of prescribed treatments must be undertaken by competent staff who are able to complete appropriate administration records accurately so that the service can demonstrate that prescribed treatments are being administered/applied as prescribed. During the Inspection period the next medicines round was not due. We found two occasions with no initials entered on the medicine chart which could not demonstrate that prescribed treatments are being administered as prescribed. The explanation for the first gap was I havent anything to explain, an omission, due to phone disruption. We discussed the use of the use of a distinct tabard to inform staff not to be disturbed during the medicines round. The staff responsible for the second gap explained I know she had it and I havent signed it. They acknowledged Im annoyed at myself for not signing the medicine chart after administration. Staff and the proprietor agreed the balance of medicine remaining could not easily be traced back to accurately demonstrate that prescribed treatments are being administered as prescribed. The type of hospital medicine chart used in the home does not easily facilitate the recording of the quantity of medicines, date, and staff initials when medicines are received into the home. The home did have a separate record of receipt of prescription medicines. However staff agreed due to the lack of further details and
Care Homes for Older People Page 4 of 11 medicines not carried forward that the home could not provide a clear accurate audit trail of medicines, received, administered and leaving the home or disposed. On balance the sample administration records were generally completed. This indicates that this requirement has therefore not been met in full. This has been carried forward with a new timescale for action 0f 28/02/2010. We were provided with a copy of the improvement plan completed by the home of what improvements the home has made. This tells you that the medication records are regularly spot checked weekly by Matron or proprietor. Any irregularities were to be discussed with Matron. We were informed that weekly checks are made, however the home failed to provide documentary evidence of any spot checks made and what action was to be taken. Two sample care plans indicated that a person living in the service was allergic to penicillin and the other person had no allergies. The medicine charts did not indicate this and both were left blank. This was relevant to any medicines supplied by the pharmacy and administered by staff. During the inspection we observed the tea-time medication round. The staff at the start of the medicines round had signed the medicine chart before administration had taken place. They explained I dont know, but realised that the Lactulose was still in the dispensary and I went back, I was nervous. However the remaining medicines procedures were correctly followed. Medicines were hygienically taken out and straight into medicine pots. A glass of water was provided and medicines were administered with a friendly patient approach. This was carried out with respect and in a dignified way. A person living in the service said I feel looked after, they look after us very well. We were also provided details of the home implementing improvements. This included homely remedies and As required PRN medication. We were provided with a example copy of a BUPA PRN protocol. The home asked questions clearly indicating that they failed to grasp what needs to be done for care staff to give PRN medicines. Individual PRN protocols or a homely remedies policy have not been implemented for people living in the service. The home had recently purchased in October 2009 a DVD on medication administration training. We were informed that some staff have watched this, however a medication training list was provided which had not been signed by any staff. What the care home does well: What they could do better: Care Homes for Older People Page 5 of 11 This inspection has identified that improvements could be made in maintaining and recording further details in the medication administration records to enable clear audit trail and spot checking of medicines in the home. As a result one of the requirements around medication standards made following the inspection in September 2009 was assessed as not fully met during our inspection of December 2009.This has been carried forward with a new timescale for action 0f 28/02/2010. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 A quality assurance system 28/02/2010 must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. To safeguard the health and welfare of people living in the home. 2 9 13 To make arrangements to 28/02/2010 ensure improved medicine chart documentation is installed to enable the quantity of all medicines received and any balances carried over from previous cycles are recorded to enable audits to take place. To demonstrate the records are kept of all medicines, received,
Page 8 of 11 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action administered and leaving the home or disposed. To safeguard the health and welfare of people living in the home. 3 9 13 To make arrangements to 28/02/2010 ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines. To include the reasons to give medicines on an as and when basis and what constitutes needed for the named person. Any when required medication must have a individual protocol for people living in the service about its use to ensure that it is given consistently and correctly. To safeguard the health and welfare of people living in the home. 4 9 18 The Registered Manager 28/02/2010 must ensure staff responsible for medicines administration including invasive or specialised techniques have the necessary skills and training. In house training schemes must have a body of up to date knowledge in the subject of medicines to
Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action include medicines with cautionary and advisory measures including for example once weekly medicine doses. To safeguard the health and welfare of people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 Action to be taken that any known allergies must be recorded on the medicine charts or nil known where appropriate. The policies and procedures relating to the handling of medication should be reviewed and updated in line with the guidance from the Royal Pharmaceutical Society document The Handling of medicines in Social Care settings published 2007. 2 9 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
